Comparison of Outcomes of Kidney Transplantation From Extremely Low Body Weight ≤5kg Versus Larger Body Weight Pediatric Donors

Jiawei Peng; Helong Dai; Hedong Zhang; Shaojie Yu; Xubiao Xie; Fenghua Peng; Gongbin Lan; Shanbiao Hu; Yu Wang; Xiaotian Tang; Yong Guo; Chen Gao; Chunhua Fang; Manhua Nie; Xiaoqiong Yuan; Mingda Zhong; Zhouqi Tang; Tengfang Li; Siyu Sun; Hengchang Yao; Jianfei Hou; Ruixue Huang; Longkai Peng

doi:10.3389/fimmu.2021.738749

Comparison of Outcomes of Kidney Transplantation From Extremely Low Body Weight ≤5kg Versus Larger Body Weight Pediatric Donors

Front Immunol. 2021 Aug 31:12:738749. doi: 10.3389/fimmu.2021.738749. eCollection 2021.

Authors

Jiawei Peng^{1

2}, Helong Dai^{1

2

3}, Hedong Zhang^{1

2}, Shaojie Yu^{1

2}, Xubiao Xie^{1

2}, Fenghua Peng^{1

2}, Gongbin Lan^{1

2}, Shanbiao Hu^{1

2}, Yu Wang^{1

2}, Xiaotian Tang^{1

2}, Yong Guo^{1

2}, Chen Gao^{1

2}, Chunhua Fang^{1

2}, Manhua Nie^{1

2}, Xiaoqiong Yuan^{1

2}, Mingda Zhong^{1

2}, Zhouqi Tang^{1

2}, Tengfang Li^{1

2}, Siyu Sun^{1

2}, Hengchang Yao^{1

2}, Jianfei Hou^{1

2}, Ruixue Huang⁴, Longkai Peng^{1

2

3}

Affiliations

¹ Department of Kidney Transplantation, The Second Xiangya Hospital of Central South University, Changsha, China.
² Clinical Research Center for Organ Transplantation in Hunan Province, Changsha, China.
³ Clinical Immunology Center, Central South University, Changsha, China.
⁴ Department of Occupational and Environmental Health, Xiangya School of Public Health, Central South University, Changsha, China.

Abstract

Background: Kidney transplantation from donors who weigh ≤5 kg is performed at only a few transplant centers owing to the high complication and low graft survival rates associated with this approach.

Methods: We retrospectively compared the results of kidney transplantation at our center between January 2015 and December 2019 based on the following pediatric donor criteria: donor body weight ≤5 kg (n=32), 5 kg< donor weight ≤20 kg (n=143), and donor weight >20 kg (n=110). We also perform subgroup analysis of kidney transplantation outcomes from ≤5 kg donors, using conventional (dual separate and classic en-bloc KTx)/novel (en-bloc KTx with outflow tract) surgical methods and allocating to adult/pediatric recipients.

Results: The death-censored graft survival rates from extremely low body weight ≤5kg at 1 month, and 1, 3, and 5 years were 90.6%, 80.9%, 77.5%, and 73.9%, respectively, which were significantly lower than that from larger body weight pediatric donors. However, the 3-, and 5-year post-transplantation eGFRs were not significantly different between the pediatric and adult recipient group. The thrombosis (18.8%) and urinary leakage (18.8%) rates were significantly higher in the donor weight ≤5 kg group. Compared with 5 kg< donor weight ≤20 kg group, donor weight ≤5kg group was at elevated risk of graft loss due to thrombosis (OR: 13.4) and acute rejection (OR: 6.7). No significant difference on the outcomes of extremely low body weight donor kidney transplantation was observed between adults and pediatric recipients. Urinary leakage rate is significantly lower in the novel operation (8.7%) than in the conventional operation group (44.4%).

Conclusions: Although the outcomes of donor body weight ≤5kg kidney transplantation is inferior to that from donors with large body weight, it can be improved through technical improvement. Donors with body weight ≤5 kg can be considered as an useful source to expand the donor pool.

Keywords: center experience; extremely low body weight; graft survival; kidney transplantation; pediatric donor; utilization.

Publication types

Comparative Study
Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Age Factors
Body Weight*
Child
Child, Preschool
Donor Selection*
Female
Graft Rejection / etiology*
Graft Survival
Humans
Infant
Infant, Newborn
Kidney Transplantation / adverse effects*
Male
Postoperative Complications / etiology*
Retrospective Studies
Risk Assessment
Risk Factors
Time Factors
Tissue Donors*
Treatment Outcome